Diagnostic usefulness of the ABCD2 score to distinguish transient ischemic attack and minor ischemic stroke from noncerebrovascular events: The North Dublin TIA study

Orla C. Sheehan, Aine Merwick, Lisa A. Kelly, Niamh Hannon, Michael Marnane, Lorraine Kyne, Patricia M.E. McCormack, Joseph Duggan, Alan Moore, Joan Moroney, Leslie Daly, Dawn Harris, Gillian Horgan, Peter J. Kelly

Research output: Contribution to journalArticle

Abstract

BACKGROUND AND PURPOSE-: Transient ischemic attack (TIA) diagnosis is frequently difficult in clinical practice. Noncerebrovascular symptoms are often misclassified as TIA by nonspecialist physicians. Clinical prediction rules such as ABCD improve the identification of patients with TIA at high risk of early stroke. We hypothesized that the ABCD score may partly improve risk stratification due to improved discrimination of true TIA and minor ischemic stroke (MIS) from noncerebrovascular events. METHODS-: Consecutive patients with TIA were identified within a prospective population-based cohort study of stroke and TIA. The cohort was expanded by inclusion of patients with MIS and noncerebrovascular events referred to a daily TIA clinic serving the population. Diagnosis was assigned by a trained stroke physician independent of ABCD score. RESULTS-: Five hundred ninety-four patients were included (292 [49.2%] TIA, 45 [7.6%] MIS, and 257 [43.3%] noncerebrovascular). The mean ABCD score showed a graded increase across diagnostic groups (MIS mean 4.8 [SD 1.4] versus TIA mean 3.9 [SD 1.5] versus noncerebrovascular mean 2.9 [SD 1.5]; P<0.00001). The ABCD score discriminated well between noncerebrovascular and cerebrovascular events-TIA (c-statistic 0.68; 95% CI, 0.64 to 0.72), any vascular event (TIA+MIS; c-statistic 0.7; 95% CI, 0.66 to 0.74), and MIS (c-statistic 0.81; 95% CI, 0.75 to 0.87)-from noncerebrovascular events. Of ABCD items, unilateral weakness (OR, 4.5; 95% CI, 3.1 to 6.6) and speech disturbance (OR, 2.5; 95% CI, 1.6, 4.1) were most likely overrepresented in TIA compared with noncerebrovascular groups. CONCLUSION-: The ABCD score had significant diagnostic usefulness for discrimination of true TIA and MIS from noncerebrovascular events, which may contribute to its predictive usefulness.

Original languageEnglish (US)
Pages (from-to)3449-3454
Number of pages6
JournalStroke
Volume40
Issue number11
DOIs
StatePublished - Nov 1 2009
Externally publishedYes

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Keywords

  • ABCD score
  • Cerebrovascular disorders
  • Diagnosis
  • Transient ischemic attack

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialized Nursing

Cite this

Sheehan, O. C., Merwick, A., Kelly, L. A., Hannon, N., Marnane, M., Kyne, L., McCormack, P. M. E., Duggan, J., Moore, A., Moroney, J., Daly, L., Harris, D., Horgan, G., & Kelly, P. J. (2009). Diagnostic usefulness of the ABCD2 score to distinguish transient ischemic attack and minor ischemic stroke from noncerebrovascular events: The North Dublin TIA study. Stroke, 40(11), 3449-3454. https://doi.org/10.1161/STROKEAHA.109.557074